ORIGINAL ARTICLE The role of patient-mode high-resolution peripheral quantitative computed tomography indices in the prediction of failure strength of the elderly women’ s thoracic vertebral body Y. Lu & M. Krause & N. Bishop & K. Sellenschloh & C.-C. Glüer & K. Püschel & M. Amling & M. M. Morlock & G. Huber Received: 23 April 2014 /Accepted: 7 August 2014 # International Osteoporosis Foundation and National Osteoporosis Foundation 2014 Abstract Summary The correlations between the failure load of 20 T12 vertebral bodies, their patient-mode high-resolution peripheral quantitative computed tomography (HR-pQCT) indices, and the L1 areal bone mineral density (aBMD) were investigated. For the prediction of the T12 vertebral failure load, the T12 HR-pQCT microarchitectural parameters added significant information to that of L1 aBMD and to that of cortical BMD, but not to that of T12 vertebral BMD and not to that of T12 trabecular BMD. Introduction HR-pQCT is a new in vivo imaging technique for assessing the three-dimensional microarchitecture of cor- tical and trabecular bone at the distal radius and tibia. But little is known about this technique in the direct measurement of vertebral body. Methods Twenty female donors with the mean age of 80.1 (7.6)years were included in the study. Dual X-ray absorpti- ometry of the lumbar spine and femur was performed. The spinal specimens (T11/T12/L1) were dissected, scanned using HR-pQCT scanner, and mechanically tested under 4° wedge compression. The L1 aBMD, T12 patient-mode HR-pQCT indices, and T12 vertebral failure loads were analyzed. Results For the prediction of vertebral failure load, the inclu- sion of BV/TV into L1 aBMD was the best model (R 2 =0.52), Tb.N and Tb.Sp added significant information to the L1 aBMD and to the cortical BMD, but none of the vertebral microarchitectural parameters yielded additional significant information to the trabecular BMD (or BV/TV) and to the vertebral BMD. Conclusion Vertebral microarchitectural parameters obtained from the patient-mode HR-pQCT analysis provide significant information on bone strength complementary to that of aBMD and to that of cortical BMD, but not to that of vertebral BMD and not to that of trabecular BMD. Keywords BMD . DXA . Failure . HR-pQCT . Mechanical testing . Microarchitecture . Osteoporosis . Vertebra Introduction Vertebral fracture in the elderly constitutes a serious health problem because of its association with back pain, disability, and the impairment of life quality [1]. Fracture is most Yongtao Lu and Matthias Krause contributed equally to this work and therefore share the first authorship. Y. Lu (*) : N. Bishop : K. Sellenschloh : M. M. Morlock : G. Huber Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany e-mail: yongtao.lu@tuhh.de Y. Lu e-mail: bennett2001@gmail.com Y. Lu Department of Mechanical Engineering and INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK M. Krause : M. Amling Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Denickestrasse 15, 21073 Hamburg, Germany M. Krause Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany C.<C. Glüer Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts Universität zu Kiel, Kiel, Germany K. Püschel Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Osteoporos Int DOI 10.1007/s00198-014-2846-7